New Jersey Judiciary
Voluntary Stipulation/Admission To Child Abuse or Neglect
Pursuant To N.J.S.A. 9:6-8.21(c)
Defendant’s Name:
County:
Docket Number:
Judge:
Defendant's Attorney:
Name(s) of Child(ren):
DOB:
Name of other parent:
Answer Each Question Completely
1.
Defendant’s Background Information
Address:
Date of birth:
How many years of school did you complete?
Do you need an interpreter?
If yes, language:
Yes
No
Do you need accommodation for a disability?
If yes, describe:
Yes
No
2.
Are you, the other parent, or the child a member of or eligible to be a
member of a federally recognized American Indian tribe?
Yes
No
3.
Is it your intent to enter into a stipulation or admission of child abuse or
neglect?
Yes
No
4.
Are you entering into the stipulation/admission willingly, knowingly, and
voluntarily?
Yes
No
5.
Did anyone force, threaten, or pressure you into making this decision?
Yes
No
6.
Did anyone offer or promise you anything to convince you to make this
decision?
Yes
No
7.
Are you currently under the influence of drugs, alcohol or prescription
medication which has affected your ability to make a clear decision?
Yes
No
8.
Are you suffering from any mental or physical disability which could
affect your judgment?
Yes
No
9.
Do you understand that you have a right to a fact-finding hearing (also
known as a trial) in this case?
Yes
No
Yes
No
10. Do you understand that by agreeing to enter into a stipulation/admission,
you give up your right to a fact-finding hearing (also known as a trial)?
Defendant's Initials:
Date:
Revised Form Promulgated by AJ Memo (09/30/2014), CN: 11539-English
page 1 of 4
11. Do you understand that at a fact-finding hearing (also known as a trial),
the Division of Child Protection and Permanency (Division) must prove
by a preponderance of the evidence that you abused or neglected your
child?
Yes
No
12. If you are giving up your right to such a trial, are you giving up your right
to trial of your own free will?
Yes
No
13. Do you understand that if there were a fact-finding hearing (also known as
a trial), a judge would determine what documentary evidence and
testimony would be admitted?
Yes
No
14. Do you understand that, through your attorney at a trial, you have the right
to challenge the evidence, cross-examine witnesses, and present evidence
and witnesses including your own testimony?
Yes
No
15. Do you understand that if at a trial you choose not to testify, the Division
still has the burden of proving the allegations against you?
Yes
No
16. Do you understand that if your child(ren) are found to have been abused or
neglected, the Division will be required to provide appropriate services to
protect your child(ren) and to assist you and your family?
Yes
No
17. Do you understand that as a result of your admission and the court's
finding based on that admission, the court will continue to hear this matter,
and you must comply with court orders?
Yes
No
a.
Do you understand that, in care and supervision cases where
the child(ren) are at home, if you fail to comply with any
court orders, the Division may seek the removal of your
child(ren)?
N/A
Yes
No
b.
Do you understand that, in a case where the Division has
custody of your child(ren), the child(ren) may remain in the
Division's custody?
N/A
Yes
No
18. Do you understand that if you do not comply with court orders or it is not
safe to return the child(ren) home within one year from the date of
placement, the Division may seek a permanent plan such as termination of
parental rights followed by adoption, kinship legal guardianship or
custody to another parent or relative?
Yes
No
19. Do you understand that the Division has determined that the child abuse or
neglect allegations against you are:
(check one)
"established" [proceed to question 20a]
Yes
No
"substantiated" [proceed to question 21a]?
Defendant's Initials:
Date:
Revised Form Promulgated by AJ Memo (09/30/2014), CN: 11539-English
page 2 of 4
20. Answer Question 20a through 20d only if admitting to "established" child abuse or neglect.
Then proceed to Question 22.
a.
Do you understand that as a result of your admission to established
child abuse or neglect and the court's finding based on that admission,
your records will be retained by the Division?
Yes
No
b.
Do you understand that as a result of your admission to established
child abuse or neglect and the court's finding based on that admission,
your name will not be forwarded by the Division to the child abuse
registry maintained by the Department of Children and Families
(DCF)?
Yes
No
c.
Do you understand that the Division's records are confidential, but
may be disclosed in limited circumstances?
Yes
No
d.
Do you understand that as a result of a finding and your admission to
abuse or neglect that you are giving up your ability, either through the
administrative process or through proceedings in court, to challenge
the retention of your record with the Division?
Yes
No
21. Answer Question 21a through 21d only if admitting to "substantiated" child abuse or neglect.
Then proceed to Question 22.
a. Do you understand that as a result of your admission to substantiated
Yes
No
child abuse or neglect and the court's finding based on that admission,
your name will be forwarded by the Division to the child abuse
registry maintained by DCF?
b.
Do you understand that on written request, the child abuse registry
records may be released to individuals identified in the statute
pursuant to the attached list of those persons who are subject to Child
Abuse Registry Information (CARI) checks?
Yes
No
c.
Do you understand that your name on the child abuse registry may
negatively affect your employment or future employment?
Yes
No
d.
Do you understand that as a result of a finding and your admission to
abuse or neglect, your name shall remain on the child abuse registry
of persons who have abused or neglected a child, and that you are
giving up your ability, either through the administrative process or
through the proceedings in court, to challenge the inclusion of your
name on the registry?
Yes
No
22. Have you had enough time to speak with your lawyer?
Yes
No
23. Has your lawyer answered all of your questions?
Yes
No
24. Are you satisfied with the services of your lawyer?
Yes
No
25. Do you have any questions regarding this stipulation/admission?
Yes
No
Defendant's Initials:
Date:
Revised Form Promulgated by AJ Memo (09/30/2014), CN: 11539-English
page 3 of 4
26. Do you understand that this form will be submitted to the court to
memorialize your voluntary decision to stipulate or admit to abuse or
neglect?
Yes
No
27. Do you understand that, as a result of your admission and the court's
finding based on that admission, the court will be making a finding under
a section of the law, N.J.S.A. 9:6-8.21(c), that relates to the facts to which
you admitted?
Yes
No
28. Do you understand that if the court does not accept your stipulation or
admission, that anything you say here today cannot be used against you in
this case?
Yes
No
29. Are you now prepared to provide the court with a factual basis for your
admission of abuse or neglect as defined by N.J.S.A. 9:6-8.21(c)?
Yes
No
Date
Defendant
Date
Defense attorney
Revised Form Promulgated by AJ Memo (mm/dd/yyyy), CN: 11539
page 4 of 4